Intervertebral disc prosthesis

ABSTRACT

The present invention relates to an intervertebral disc prosthesis preferably comprising at least three pieces including an upper plate ( 1 ), a lower plate ( 2 ) and a mobile core ( 3 ) at least in relation to the lower plate ( 2 ), co-operation means ( 23, 33 ) allowing to limit or eliminate the movements of the core ( 3 ) in relation to the lower plate ( 2 ), in translation and in rotation, respectively, about an axis substantially parallel to the lower plate ( 2 ) and about an axis substantially perpendicular to the lower plate ( 2 ), at least one part of the surface of at least one plate being concave and complementary with a convex surface ( 30 ) of the core ( 3 ), with which it is in contact, wherein the tip ( 31 ) of the convex surface ( 30 ) of the core ( 3 ) is off centre, in at least one direction, in relation to the centre ( 32 ) of this convex surface ( 30 ).

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority under 35 U.S.C. 119 to French PatentApplication No. 04 04501, filed in FRANCE on Apr. 28, 2004.

BACKGROUND

The present invention relates to an intervertebral disc prosthesis,intended to be substituted for fibro-cartilaginous discs ensuring a bondbetween the vertebrae of the spinal column.

Various types of intervertebral disc prostheses are known in the priorart. Numerous prostheses, such as for example in the patent applicationFR 2 846 550 and WO 02 089 701, are constituted in a lower plate and anupper plate forming a sort of cage around a central core. A part ofthese prostheses enables the upper plate to swivel in relation to thecentral core and optionally permits the central core to slide inrelation to the lower plate. This sliding of the central core inrelation to the lower plate is an essential characteristic, as it mustallow spontaneous positioning of the core in the ideal position toabsorb constraints imposed on the prosthesis, during movements made bythe patient wearing the prosthesis. The displacement of the core,co-operating with at least a plate about an uneven surface, enables aninclination between the plates of the prosthesis which facilitates themobility of the patient wearing the prosthesis. The displacement of thecore also prevents it from creeping when subjected to major constraints.

In this context, it is significant to propose a prosthesis which allowsto impose a permanent inclination between the plates and induces, forexample, lordosis. Depending on the disorder of the spinal column of thepatient wearing the prosthesis, it is sometimes preferable that theprosthesis allows a correction of this disorder. In line with the wishesof the surgeon, the displacement of the core should be restricted in atleast one direction. However, when the patient moves, the relativeposition of the elements of the prosthesis can be modified, within thepermitted range of displacement.

One aim of some embodiments of the present invention is to propose anintervertebral disc prosthesis allowing limited movements of thedifferent pieces of the prosthesis between one another and comprising acore used to restrict its displacement in at least one direction.

SUMMARY

An intervertebral disc prosthesis includes at least three piecesincluding a first plate, a second plate, and a mobile core, at least inrotation, at least in relation to one of the plates, the core having acurved surface in contact with at least a part of a complementary curvedsurface of the first plate, and a substantially flat surface in contactwith at least a part of a substantially flat of the second, male andfemale co-operation means situated near the periphery of the secondplate and of the core allowing, to limit or prevent, the movements intranslation of the core in relation to the second plate to along an axissubstantially parallel to the substantially flat surfaces, and allowingto limit or prevent the movements in rotation of the core in relation tothe second plate, about an axis substantially perpendicular to thesubstantially flat surfaces, at least one part of the surface of atleast one plate being concave and complementary with a convex surface ofthe core, with which it is in contact, wherein the tip of the convexsurface of the core is off centre, in at least

one direction, in relation to the geometric centre of this convexsurface of the core.

According to another embodiment, the rest position of the core, thatbeing when the patient is motionless, is shifted in the oppositedirection to that of the off centre of the tip of the convex surface ofthe core, thanks to the fact that the axes of symmetry of the first andsecond plates are aligned when the plates are anchored on the vertebraeand that the concave surface of at least one plate, complementary withthe convex surface of the core, induces the aligning of the off-centretip of this convex surface of the core with the axes of symmetry of theplates and therefore a shifting of the core in the opposite direction tothat of the off centre of the tip of its convex surface, which provokesa bringing together of the co-operation means present on the core andthose present on at least one plate, this bringing together consequentlylimits the displacement of the core in the opposite direction to that ofthe off centre of the tip of its convex surface.

According to another embodiment, the same plates can be assembled withdifferent cores, the difference between the cores consisting in theposition of the tip of their convex surface in relation to the centre ofthis convex surface of the core.

According to another embodiment, the same cores can be assembled withdifferent plates, the difference between the plates consisting in theangle between the median planes representing the upper and lowersurfaces of the plates.

According to another embodiment, an angle between the upper surface ofthe upper plate and the lower surface of the second plate can be imposedeither by the fact that the median planes representing the upper andlower surfaces of the second plate and/or the first plate create anangle, or by restricting, thanks to the co-operation means, movements ofthe core about a position imposing an inclination of at least one of theplates.

According to another embodiment, the same plates can be assembled withcores of different thicknesses and/or sizes.

According to another embodiment, at least the lower surface of the coreand the upper surface of the second plate are plane.

According to another embodiment, the dimensions of each maleco-operation means are slightly less than those of each femaleco-operation means so as to allow slight clearance between the core andthe second plate.

According to another embodiment, the dimensions of each male means aresubstantially the same as those of each female means so as to preventany clearance between the core and the second plate.

According to another embodiment, the core is made of polyethylene.

According to another embodiment, first and second plates are made ofmetal.

According to another embodiment, the second plate comprises female meansco-operating with male means of the core.

According to another embodiment, the male means of the core are twocontact plates situated on the two side edges of the core and the femalemeans of the second plate are four walls situated, in pairs, on each ofthe two lateral edges of the second plate.

According to another embodiment, the walls forming the femaleco-operation means of the second plate are curved toward the centre ofthe prosthesis, so as to cover at least a part of the male means of thecore and to prevent it from lifting.

According to another embodiment, the second plate comprises male meansco-operating with female means of the core.

According to another embodiment, the male means of the second plate aretwo contact plates facing one another on two edges of the prosthesis,and the female means of the core are two recesses.

According to another embodiment, the male means of the second plate aretwo walls facing one another in the vicinity of two edges of theprosthesis, and the female means of the core are recesses.

According to another embodiment, the male means of the second plate aretwo nibs curved toward the interior of the prosthesis and facing oneanother on two edges of the prosthesis, and the female means of the coreare two recesses.

According to another embodiment, at least one of the nibs is replaced bya contact plate fitted with a bore on which is fixed a lug by way of apin penetrating the bore.

According to another embodiment, the first plate is bulged on at least apart of its upper surface to adapt to the form of the vertebrae.

BRIEF DESCRIPTION OF THE DRAWINGS

Other features and advantages of the various embodiments are in thedescription herein below, given in reference to the attached drawings,in which:

FIGS. 1 a and 1 b respectively illustrate, a side view and a top view ofthe core of the prosthesis according to one embodiment of the invention,

FIGS. 2 a and 2 b respectively illustrate a front view and a side viewof the prosthesis, in a first embodiment of the invention, and FIGS. 2 cand 2 d respectively illustrate a front view in perspective and a sideview of the prosthesis, in a second embodiment of the invention,

FIGS. 3 a and 3 b respectively illustrate a top view and a cross sectionview according to the plan A-A in FIG. 3 a, of the lower plate of theprosthesis in an embodiment of the invention, FIG. 3 c illustrates a topview of the lower plate with the core and FIGS. 3 d and 3 e respectivelyillustrate a top view and a cross section view according to the plan B-Bin FIG. 3 d, of the upper plate of the prosthesis in an embodiment ofthe invention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The intervertebral disc prosthesis according to one embodiment of thepresent invention is constituted in a first plate (1) articulated inrelation to a second plate (2) by means of a core (3), as evident inparticular in FIGS. 2 a to 2 d. In the following description, the firstplate (1) is called the upper plate and the second plate (2) is calledthe lower plate, according to the orientation given to the prosthesisshown in the drawings. The prosthesis herein described could also beinversely oriented between the vertebrae, so that the first plate (1)would be the lower plate and the second plate (2) would be the upperplate. As described below, the first plate comprises a curved surface(concave or convex) cooperating with a curved and complementary surface(convex or concave) of the nucleus and the second plate comprises asubstantially flat surface cooperating with a substantially flat surfaceof the nucleus. These various surfaces described can belong to any ofthe first and second plate of the prosthesis without departing from thescope of the invention.

An advantage of the prosthesis according to this embodiment of thepresent invention is that it comprises simple pieces which can bedimensioned in order to be adapted to the different vertebrae of thespinal column.

The core (3) is of slight thickness (from 3 to 15 mm, depending on thevertebrae between which the prosthesis is to be inserted). For goodabsorption of the constraints, the core (3) could, for example, be madeof polyethylene, a compressible material simulating the physicalproperties of elasticity of natural intervertebral discs.

The core (3) preferably has a convex part (30) on at least a part of atleast one of its upper and lower surfaces. Preferably, the core (3) alsohas male or female co-operation means (33) complementary withrespectively female or male co-operation means (23) present on at leastone of the plates (1, 2).

The description of one of these embodiments will now be dealt with inreference to FIGS. 1 to 3. In this embodiment, it is the upper surfaceof the core (3) which has a convex part (30), evident particularly inFIG. 1 a. This convex surface (30) of the core (3) is complementary witha concave part (10) of the upper plate (1), evident particularly inFIGS. 3 d and 3 e. This concave part (10) allows to incline the upperplate (1) when the patient wearing the prosthesis bends over. The lowersurface of the core (3) and the upper surface of the lower plate (2)could be plane so as to permit clearance of the core (3) in relation tothe lower plate (2), both in translation according to an axissubstantially parallel to the lower plate (2), and in rotation about anaxis substantially perpendicular to the lower plate (2). Duringmovements by the patient wearing the prosthesis, this inclination of theupper plate (1) and this clearance of the core will allow displacementof the core (3) towards the ideal position to absorb the constraintsapplied to the prosthesis. The movement between the upper plate (1) andthe core (3), as well as the clearance of the core (3) in relation tothe lower plate (2) thus allow the patient to move, and, optionally, toeliminate the defects of positioning the prosthesis. This clearancelikewise has the advantage of preventing premature wear due to theconstraints applied to the prosthesis.

The intervertebral disc prosthesis according to some embodiments allows,for example, to correct the defects of lordosis. The presence of anangle between the upper plate (1) and the lower plate (2) of theprosthesis could be desirable. Such an angle could be obtained by makingan upper plate, whose median planes representing its lower and uppersurfaces create an angle. Another possibility involves the lower platewhereof the median planes representing its lower and upper surfacescreate an angle, as illustrated in FIGS. 2 c and 2 d, in which the lowersurface (20) of the lower plate (2) create an angle with its uppersurface. Another possibility to obtain such an angle is only allowed byprostheses of the same type as those of preferred embodiments of theinvention and consists in a slightly offset position of the core inrelation to the centre of the prosthesis. This slightly offset positionof the core can, for example, be maintained thanks to an adjustablepositioning of the male and female co-operation means betweenthemselves. If the surgeon wishes, for example, that the prosthesisinduces lordosis which remains within a range of values, he will selecta prosthesis whose core (3) can have slight clearance in translation andin rotation in relation to the lower plate (2), but about a positionimposing a slight permanent inclination of at least one of the plates,thanks to an accurate adjustment of the co-operation means between thecore and the lower plate (2).

The prosthesis according to preferred embodiments has a characteristicwhich improves its behaviour once positioned between the vertebrae ofthe patient. This feature resides in the fact that the tip (31) of theconvex surface (30) of the core (3) is off centre in relation to thecentre (32) of this convex surface (30) of the core (3). The centre ofthe concave part (10) of the upper plate (1), complementary with thisconvex surface (30), swivels around this tip (31) of the convex surface(30). Although being mobile about this tip (31), the upper plate (1)will therefore be on average centred on the tip (31) of the convexsurface (30) of the core (3). The vertical axes which pass through thecentres of two adjacent vertebrae are generally aligned, even thoughthey can be slightly inclined depending on the movements of the patientor depending on the zone in question of the spinal column. It istherefore important that the vertical axes which pass through thecentres of the plates (1, 2) and through the tip (31) of the convexsurface (30) of the core are also aligned. So that these axes arealigned, the off-centre tip (31) of the convex surface (30) of the core(3) must be in the axis of the centres of the plates and therefore ofthe core (3) that being off centre in relation to the lower plate (2).Thus the rest position of the core (3) will be off centre in relation tothe centre of the prosthesis. As illustrated in FIG. 3C, in which theupper plate (1) is not shown for reasons of clarity, the core is offcentre in relation to the centre of the prosthesis and the co-operationmeans (33) of the core (3) are in contact with the co-operation means(23) of the lower plate (2), in the zones encircled with a dotted line.FIG. 2B also emphasises this shift of the core (3) in relation to theside view of the centre of the prosthesis. The shifting of the core (3)and the contact between the co-operation means (33) and those of thelower plate (23) will also restrict the displacement of the core (3) inthe opposite direction to that of the off centre of the tip (31) of theconvex surface (30). We can then choose the direction and amplitude ofthe shift to be made to the tip (31) of the convex surface (30) of thecore (3), in order to obtain a desired reduction in displacement. Thecore (3) can then, for example, only be displaced in the direction ofthe shifting of the tip (31) in relation to the centre (32) of theconvex surface (30) of the core (3). If the patient wearing theprosthesis according to this embodiment bends over in the oppositedirection to this shifting of the tip (31), the core (3) can then movein the direction of this shifting of the tip (31), thus reducing theshifting between the vertical axes passing through the centres of theplates, which is what would happen if the tip (31) of the convex surface(30) of the core (3) was not off centre. An essential consequence ofthis feature is therefore that it allows to permanently restrict theshifting between the vertical axes passing through the centres of thevertebrae, even when the patient bends over. For example, we can choosea core (3) whose tip (31) of its convex surface (30) is off centre tothe rear so that the core, in the rest position, is completely offcentre to the front of the prosthesis and can not be displaced furtherforward. Such a core therefore restricts the displacement of the core tothe front and reduces the angle to which the patient can bend backwards.However, if the patient bends forward, the upper plate (1) inclines tothe front, thus inducing a shifting of the vertical axis passing throughits centre, in relation to the vertical axis passing through the centreof the lower plate (2). However, this shifting is eliminated bydisplacing the core (3) to the rear of the prosthesis. This shifting isbetter eliminated when the upper plate is mobile about the off-centretip (31) of the convex surface (30) of the core (3). The core (3) withan off-centre tip (31) then wedges into the rear of its opening in theprosthesis and allows a better alignment of the vertical axes passingthrough the centres of the plates than a core with an off-centre tipdoes.

Another advantage of some embodiments relates to the implanting ofprostheses between the vertebrae of a recipient patient. Duringimplantation of prostheses with mobile cores, the core of the prosthesishas a tendency to move to a far end of its stroke in its opening withinthe prosthesis. The patient is thus equipped with a prosthesis whichimposes a slight inclination to his/her spinal column. This inclinationcan be eliminated thanks to the movements of the patient as soon ashe/she has recovered from the operation. However, this inclinationprovokes considerable discomfort for the patient. Thanks to theoff-centre position of the tip (31) of the core (3) of the prosthesisaccording to preferred embodiments, the core (3) would tend to move intoan off-centre rest position, in which the tip (31) is aligned inrelation to the axes of the upper and lower plates. Thanks to thisspontaneous alignment of the axes of the prosthesis, no inclination ofthe plates will be imposed in the rest position and the patient willhave been equipped with a prosthesis that does not provoke anydiscomfort.

In the embodiment in FIGS. 1 to 3, the core (3) has male co-operationmeans (33) complementary with female co-operation means (23) present onthe lower plate (2). The male co-operation means (33) of the core (3)are, for example, hasps substantially parallelepiped in shape, asparticularly visible in FIGS. 1 a and 1 b. The female co-operation means(23) can, as particularly visible in FIGS. 3 a and 3 b, consist, forexample, in four walls situated, in pairs, on each of the two side edgesof the lower plate (2). These walls could be curved toward the centre ofthe prosthesis, so as to cover at least a part of the male co-operationmeans (33) of the core (3) and avoid lifting the core (3) and the upperplate (1). In this embodiment illustrated in FIGS. 1 to 3, thedimensions of each male means (33) of the core (3) are slightly lessthan those of each female means (22) of the lower plate (2), so as toallow a restricted clearance of the core (3) in relation to the lowerplate (2), both in translation according to an axis substantiallyparallel to the lower plate (2), and in rotation about an axissubstantially perpendicular to the lower plate (2). These co-operationmeans (23, 33) also prevent the core (3) from ejecting out of theprosthesis, in the event of too much constraint on the prosthesis.

In an alternative embodiment not shown, the dimensions of each maleco-operation means (33) of the core (3) are substantially the same asthose of each female co-operation means (23) of the lower plate (2), soas to avoid any clearance of the core (3) in relation to the lower plate(2), both in translation and in rotation. In the latter case, the onlypermitted movement of the prosthesis is that of the upper plate (1) inrelation to the core (3).

In an alternative embodiment not shown, the core (3) has femaleco-operation means, consisting, for example, in complementary recessesof the male means present on the lower plate (2). These male means ofthe lower plate (2) can consist, for example, in two contact plates ortwo nibs, for example curved toward the interior of the prosthesis andfacing one another on two edges of the lower plate (2).

In another alternative embodiment not shown, the lower plate (2) hasdowels. The core (3), by way of complement, has two wells under itslower surface. The dimensions of the dowels of the lower plate (2) andof the wells of the core (3) will be adapted according to the desiredresult, by choice, of slight clearance of the core in translation and inrotation or any clearance.

In an alternative embodiment not shown, a part of the upper surface ofthe upper plate (1) is bulged, so as to better adapt to the vertebra onwhich the prosthesis is intended to be placed, the lower surface of thevertebrae being hollow. The bulged part of the upper plate (1) is thensituated in the front part of the upper plate. The lower plate (2) issubstantially plane as its lower surface has no need to be bulged orhollow, since the upper surface of the vertebrae is substantially flat.

It must be evident for specialists that the invention allows embodimentsin numerous other specific forms without departing from the scope ofapplication of the invention as claimed. As a consequence, theembodiments must be considered by way of illustration, but can bemodified within the scope defined by the range of the attached claims,and the invention does not have to be limited to the details givenabove.

1. An intervertebral disc prosthesis comprising at least three piecesincluding a first plate, (1), a second plate, (2) and a mobile core (3),at least in rotation, at least in relation to one of the plates (1, 2),the core (3) having a curved surface in contact with at least a part ofa complementary curved surface of the first plate (1), and asubstantially flat surface in contact with at least a part of asubstantially flat of the second, male and female co-operation means(23, 33) situated near the periphery of the second plate (2) and of thecore (3) allowing, to limit or prevent, the movements in translation ofthe core in relation to the second plate to along an axis substantiallyparallel to the substantially flat surfaces, and allowing to limit orprevent the movements in rotation of the core in relation to the secondplate, about an axis substantially perpendicular to the substantiallyflat surfaces, at least one part of the surface of at least one platebeing concave and complementary with a convex surface (30) of the core(3), with which it is in contact, wherein the tip (31) of the convexsurface (30) of the core (3) is off centre, in at least one direction,in relation to the geometric centre (32) of this convex surface (30) ofthe core (3).
 2. Intervertebral disc prosthesis set forth in claim 1,wherein the rest position of the core (3), that being when the patientis motionless, is shifted in the opposite direction to that of the offcentre of the tip (31) of the convex surface (30) of the core (3),thanks to the fact that the axes of symmetry of the first (1) and second(2) plates are aligned when the plates are anchored on the vertebrae andthat the concave surface (10) of at least one plate (1), complementarywith the convex surface (30) of the core (3), induces the aligning ofthe off-centre tip (31) of this convex surface (30) of the core (3) withthe axes of symmetry of the plates (1, 2) and therefore a shifting ofthe core (3) in the opposite direction to that of the off centre of thetip (31) of its convex surface (30), which provokes a bringing togetherof the co-operation means (33) present on the core (3) and those (23)present on at least one plate (2), this bringing together consequentlylimits the displacement of the core (3) in the opposite direction tothat of the off centre of the tip (31) of its convex surface (30). 3.Intervertebral disc prosthesis set forth in claim 1, wherein the sameplates (1, 2) can be assembled with different cores (3), the differencebetween the cores (3) consisting in the position of the tip (31) oftheir convex surface (30) in relation to the centre (32) of this convexsurface (30) of the core (3).
 4. Intervertebral disc prosthesis setforth in claim 1, wherein the same cores (3) can be assembled withdifferent plates (1, 2), the difference between the plates consisting inthe angle between the median planes representing the upper and lowersurfaces of the plates.
 5. Intervertebral disc prosthesis set forth inclaim 1, wherein an angle between the upper surface of the upper plate(1) and the lower surface of the second plate (2) can be imposed eitherby the fact that the median planes representing the upper and lowersurfaces of the second plate (2) and/or the first plate (1) create anangle, or by restricting, thanks to the co-operation means (23, 33),movements of the core (3) about a position imposing an inclination of atleast one of the plates (1, 2).
 6. Intervertebral disc prosthesis setforth in claim 1, wherein the same plates (1, 2) can be assembled withcores (3) of different thicknesses and/or sizes.
 7. Intervertebral discprosthesis set forth in claim 1, wherein at least the lower surface ofthe core (3) and the upper surface of the second plate (2) are plane. 8.Intervertebral disc prosthesis set forth in claim 1, wherein thedimensions of each male co-operation means (33) are slightly less thanthose of each female co-operation means (23) so as to allow slightclearance between the core (3) and the second plate (2). 9.Intervertebral disc prosthesis set forth in claim 1, wherein thedimensions of each male means (33) are substantially the same as thoseof each female means (23) so as to prevent any clearance between thecore (3) and the second plate (2).
 10. Intervertebral disc prosthesisset forth in claim 1, wherein the core (3) is made of polyethylene. 11.Intervertebral disc prosthesis set forth in claim 1, wherein first (1)and second (2) plates are made of metal.
 12. Intervertebral discprosthesis set forth in claim 1, wherein the second plate (2) comprisesfemale means (23) co-operating with male means (33) of the core (3). 13.Intervertebral disc prosthesis set forth in claim 12, wherein the malemeans (33) of the core (3) are two contact plates situated on the twoside edges of the core (3) and the female means (23) of the second plate(2) are four walls situated, in pairs, on each of the two lateral edgesof the second plate (2).
 14. Intervertebral disc prosthesis set forth inclaim 13, wherein the walls forming the female co-operation means (23)of the second plate (2) are curved toward the centre of the prosthesis,so as to cover at least a part of the male means (33) of the core (3)and to prevent it from lifting.
 15. Intervertebral disc prosthesis setforth in claim 1, wherein the second plate (2) comprises male meansco-operating with female means of the core (3).
 16. Intervertebral discprosthesis set forth in claim 15, wherein the male means of the secondplate (2) are two contact plates facing one another on two edges of theprosthesis, and the female means of the core (3) are two recesses. 17.Intervertebral disc prosthesis set forth in claim 15, wherein the malemeans of the second plate (2) are two walls facing one another in thevicinity of two edges of the prosthesis, and the female means of thecore (3) are recesses.
 18. Intervertebral disc prosthesis set forth inclaim 15, wherein the male means of the second plate (2) are two nibscurved toward the interior of the prosthesis and facing one another ontwo edges of the prosthesis, and the female means of the core (3) aretwo recesses.
 19. Intervertebral disc prosthesis set forth in claim 18,wherein at least one of the nibs is replaced by a contact plate fittedwith a bore on which is fixed a lug by way of a pin penetrating thebore.
 20. Intervertebral disc prosthesis set forth claim 1, wherein thefirst plate (1) is bulged on at least a part of its upper surface toadapt to the form of the vertebrae.